Jaw Diseases and Pain Management

Painful Jaw Diseases

• Fractures, Osteomyelitis, Infected cysts, Malignant neoplasms, Sickle cell infarcts are all painful jaw diseases.
• Pain in edentulous patients: Denture trauma, excessive vertical dimension, diseases of the denture bearing mucosa, diseases of the jaws, and teeth or roots erupting under a denture can all cause pain in edentulous patients.
• Postoperative pain: Alveolar osteitis (dry socket), fracture of the jaw, damage to the TMJ.Osteomyelitis, and damage to nerve trunks or involvement of nerves in scar tissue can cause pain after surgery.
• Pain induced by mastication: Diseases of the teeth and supporting tissues, diseases of TMJ, pain dysfunction syndrome, temporal arteritis, trigeminal neuralgia (rarely), and salivary calculi can induce pain during mastication.
• Pain from extra-oral disease (referred pain): Diseases of the maxillary antrum like acute sinusitis and carcinoma, particularly when it involves the antral floor, diseases of salivary glands like acute parotitis, salivary calculi, Sjogren’s syndrome, and malignant neoplasms, and diseases of the ears like otitis media, neoplasms, and myocardial infarction can cause referred pain to the jaw.

Neurological Diseases

• Trigeminal neuralgia: Characterized by paroxysmal and severe pain confined to the distribution of one or more divisions of the trigeminal nerve. The pain is sharp, stabbing, and lasts for seconds or minutes. A trigger zone exists, where stimuli like touching, cold air, or tooth-brushing can provoke an attack.
• Glossopharyngeal neuralgia: This rare condition is characterized by pain similar to trigeminal neuralgia, but felt in the base of the tongue and fauces on one side. The pain can radiate deeply into the ear. The pain is sharp, lancinating, and transient, typically triggered by swallowing, chewing, or coughing.
• Post herpetic neuralgia: Up to 10% of patients who have trigeminal herpes zoster, particularly if elderly, may develop persistent neuralgia. The pain is more variable in character and severity than trigeminal neuralgia, typically persistent rather than paroxysmal.
• Intracranial tumors: Pain resembling trigeminal neuralgia can rarely be caused by intracranial tumors. Features suggesting an intracranial lesion are associated sensory loss, especially if associated with cranial nerve palsies.
• Bell’s palsy: This is a common cause of facial paralysis, probably resulting from compression of the facial nerve in its canal due to inflammation and swelling. It is often caused by a viral infection, particularly herpes zoster. Pain in the jaw sometimes precedes the paralysis or there may be numbness in the side of the tongue.

Muscular Pain

• Myofascial pain dysfunction (MFD), TMJ pain dysfunction (TMPD), Facial arthromyalgia (FAM): These share a triad of common symptoms: jaw clicking, jaw locking (or limitation of movements), and orofacial pain. These symptoms appear to be related to muscle spasms and subsequent ischemic pain arising from stress, joint damage, or habits like tooth clenching or grinding.
• Etiopathogenesis: Trauma and stress are thought to predispose through increasing tension in the masticatory muscles.
• Gender predominance: Females
• Age: Teens and up to 40 years
• Extraoral: Headache, neck aches, and lower back pain may be present.

Psychogenic Diseases

• Psychogenic (atypical) facial pain: Women of middle age or older are mainly affected. Absence of organic signs, poorly localized pain, bizarre descriptions of pain, delusional symptoms, lack of response to analgesics, unchanging pain persisting for many years, lack of any triggering factors.
• Burning mouth syndrome: Middle aged or older women are mainly affected. No visible abnormality or evidence of organic disease, no hematological abnormality, pain typically described as burning, persistent and unremitting soreness without aggravating or relieving factors, no response to analgesics, bizarre patterns of pain radiation inconsistent with neurological or vascular anatomy, sometimes bitter or metallic taste associated, associated depression, anxiety or stressful life situation, obsession with symptoms which may rule the patient’s life, constant search for reassurance and treatment by different practitioners.
• Psychogenic dental pain (atypical odontalgia): This is a less common variant of atypical facial pain. Pain is often precisely localized in one tooth or in a row of teeth, sensitive to heat, cold, or pressure. If dental disease is found treatment has no effect, or if the tooth is removed, the pain moves to an adjacent tooth.

Pain Classification

• Somatic pain: due to noxious stimulation of normal neural structure that innervate body tissue.
• Neurogenic pain: due to pathology or abnormality in the neural structures themselves (within the nervous system), i.e. neuropathy
• Psychogenic pain: due to psychic stress.

Explore various painful jaw diseases including fractures, osteomyelitis, and more. This quiz also covers pain in edentulous patients and postoperative complications. Learn about the causes and management of pain related to mastication and extra-oral diseases.